On December 22nd, the Summit made the following recommendations to Governor-elect Rauner:
Both the state and local governments in Illinois are spending tens of millions of dollars on persons with mental illnesses in the criminal justice system. The state prisons are dramatically overcrowded and more than 8,000 inmates have serious mental illnesses. Illinois is attempting to settle a class action against the Department of Corrections over its failure to provide minimally adequate mental health services to inmates. Each inmate costs the state over $20,000/year and this cost will go up when the state begins to comply with its legal obligations to these inmates. Fortunately, Illinois’ decision to expand Medicaid under the Affordable Care Act will permit Illinois to reduce significantly the number of persons with mental illnesses in state prisons (and county jails). Historically, fewer than 10% of the persons entering the criminal justice system have been eligible for Medicaid and few had private insurance. Thus, most inmates with mental illnesses had never received treatment for their illnesses. With Medicaid expansion more than 90% of this population will be eligible for Medicaid and, therefore, will be able to receive treatment for their illnesses. Studies have consistently shown that such treatment will dramatically reduce involvement in the criminal justice system. Illinois must prioritize the enrollment of persons in the criminal justice system in Medicaid and ensure that the appropriate mental health services are made available to this population in a timely fashion. It is particularly important that eligible persons leaving our state prisons are promptly enrolled in Medicaid. Other cost-effective diversion programs include:
• Crisis Intervention Team (CIT) training for all law enforcement officers
• Temporary treatment facilities for persons leaving prisons and jails
• Jail diversion programs modeled after the Bexar County (Texas) Center for Health Care Services)
As documented in the recent Chicago Tribune series, Illinois is also spending substantial sums of money on children with mental illnesses in the juvenile justice system, but their illnesses often go untreated. The Summit has many suggestions for diverting children and adolescents out of the juvenile justice system including:
• ending parental custody relinquishment as a condition for receiving services
• full participation in the Federal Early and Periodic Screening Diagnosis and Treatment (EPSDT) program
• restoring the Individual Care Grant program administered by the Department of Human Services for children with mental illnesses
• enforcing federal and state mental health insurance parity laws so that private insurance, rather than the state, will pay for mental health services, for minors
Medicaid is the largest single source of funding for mental health services in Illinois (and every other state). However, Medicaid funds are often wasted on expensive and ineffective services. We suggest the following changes:
• take advantage of the Federal Section 1115 waiver program to insure the availability of community services which will prevent the use of more expensive institutional care.
• reduce the state’s excessive reliance on expensive nursing homes, specifically including Specialized Mental Health Rehabilitation Facilities, to house persons with mental illnesses
• expand the use of cost-effective community services including:
• supportive housing
• supported employment
• peer supports services delivered by Certified Recovery Support Specialists
• insure that the mental health services provided under the Medicaid expansion program are fully aligned with the traditional Medicaid program
Social Impact Bonds
Illinois should join government units across the country in taking advantage of “social impact bonds” or “pay for performance” funding mechanisms to create public/private partnerships to improve the delivery of mental health services. The Summit has concrete ideas about how such programs could reduce state spending on persons with mental illnesses, including those in prisons, jails and state hospitals and those being hospitalized at state expense in private hospitals.
Mental Health Insurance Parity
The Federal government has recently published detailed regulations to implement the Mental Health Parity and Addiction Equity Act. Illinois also has a state mental parity law. These laws are intended to require private health insurance companies to cover mental illnesses in a manner equal to the coverage of non-psychiatric disorders. Effective enforcement of these parity laws will increase the availability of mental health services which will keep people employed and save Illinois resources. The Illinois Department of Insurance should take the lead in enforcing state and federal parity laws.
Access to Medications
While psychotropic medications can be expensive, there is substantial research showing that restricting access to these medications increases costs because it results in increased hospitalizations and other negative and expensive outcomes. Illinois should removed or reduce burdensome prior authorization requirements for medications in its Medicaid program and work to create standardized prior authorization procedures for private insurance.
Sale of Tinley Park Mental Health Center
Illinois has proposed to sell the land under the now-defunct Tinley Park Mental Health Center to the Village of Tinley Park for a sum that is substantially less than its market value. This matters to mental health advocates because Illinois law requires the proceeds of the sale to be reinvested in mental health services. Given the substantial cuts in state funding for mental health services over the past decade, these funds are greatly needed. The sale should be suspended until a fair appraisal of the value of the land can be made and Illinois should attempt to obtain as much as it can for this property.
Additional Federal Funding for Mental Health Services
The United States Department of Health and Human Services will be awarding planning grants on January 1, 2016 to eight states as a prelude to funding new Certified Community Behavioral Health Clinics (CCBHC). This represents an opportunity to obtain substantial Federal funds to improve Illinois’ community mental health services. Illinois should apply for a CCBHC planning grant.
Here is a link to Governor Rauner’s Transition Team Report